Elbow Dislocation

Scenario

A 50 Year old builder presents to A+E after falling from a ladder and landing onto his right arm. A primary survey and secondary survey has been completed. The only injury of note is swelling and tenderness over his Right elbow.

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This is a lateral and AP plane film radiograph of a skeletally mature individuals right elbow. The most obvious abnormality is that there is a posterior dislocation of the elbow. 

I would perform this procedure under sedation in the emergency department. I would flex the elbow to 30 degrees in supination to unlock the olecranon from the olecranon fossa, following this I would apply longitudinal traction and gently lever the olecranon over the distal humerus.

After reduction I would take the elbow through gentle range of movement to confirm congruent reduction has been obtained and can be maintained. Then I would place the elbow in an above elbow backslab for review in 10 days following this provided stable they could be placed in a hinged elbow brace for 2-3 weeks.

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You successfully reduce the elbow.

  • Fracture of the radial head
  • Dislocated elbow
  • Coronoid fracture

Primary stabilisers

  • LCL complex
  • Anterior MCL bundle
  • Ulnohumeral joint

Secondary stabilisers

  • Radiocapitellar joint
  • Capsule
  • Flexor and extensor origins

Dynamic stabilisers

  • The anconeus
  • Brachialis
  • Triceps

 

O’Driscoll has described the pathoanatomy of elbow dislocations. He has described a ring of instability caused by sequential tearing of the soft tissues. Patients axially load a supinated forearm. The sequence of tearing:

  • Lateral collateral ligament
  • Anterior capsule
  • Medial collateral ligament
  • Common flexor or extensor origins may also be avulsed.